Provider Demographics
NPI:1447455316
Name:TERRY CHIROPRACTIC HEALTH CENTER, LLC
Entity type:Organization
Organization Name:TERRY CHIROPRACTIC HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-440-0500
Mailing Address - Street 1:2960 DIAGONAL HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1412
Mailing Address - Country:US
Mailing Address - Phone:303-440-0500
Mailing Address - Fax:303-440-4621
Practice Address - Street 1:2960 DIAGONAL HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1412
Practice Address - Country:US
Practice Address - Phone:303-440-0500
Practice Address - Fax:303-440-4621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1561261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty